DENTURES & DENTAL IMPLANTS - A CLOSE REVIEW

What are Dentures?

 Dentures are made as replacements for missing teeth that are not fixed. You can take it out yourself and put it back into the mouth. They do not feel the same as your natural teeth and you will need some time to get used to it. The dentures made now days look more natural and are more comfortable than ever. 

The two major kinds of dentures are

• :full dentures
• partial dentures 

When you consult your dentist for denture he or she will advise regarding the appropriate one for you based on if some or all of your teeth need to be replaced and the cost factor.

How do Dentures Work 

A full denture has an upper part and a lower part. The upper denture covers the entire roof of your mouth (the hard palate) and the lower denture has a horseshoe shape to accommodate your tongue. Your dentist will take an impression of your mouth and make the denture in a dental laboratory. 

Conventional Full Denture:

 Before placing conventional full denture the remaining teeth are removed and time is given for the gum tissue to heal. Sometimes it can take several months for healing. During this period you are without teeth. 

Immediate Full Denture: 

These dentures are placed straight away after your remaining teeth are removed. The advantage of this type of denture is that you are not without teeth but you will need to visit your dentist later on to have it relined. 

Partial Denture: 

A partial denture is made on a framework which gets attached to your natural teeth when you put the denture in your mouth. These are often used as a removable alternative to bridges. 

How Long Before I Get Used to My Dentures 

You may take a first few weeks or even months to get used to your dentures. Initially you may feel awkward or uncomfortable, and eating and speaking comfortably with them may take sometime. For sometime you may have problems such as excessive saliva flow, or minor irritation. If the irritation is persistent consult your dentist.

 How Long do Dentures Last

 A denture undergoes normal wear and tear with time. It may need to be relined, remade, or rebased after sometime. As your mouth naturally changes with age you may need to change your denture. Consult your dentist at least once a year for a checkup. 

Tips to care for your dentures

• Handle your denture carefully as they are delicate and may break if it is dropped.
• Do not let your dentures to dry after removing them. Keep your dentures in denture cleanser soaking solution or in plain water after removing it.
• Brush to clean your dentures. It helps to remove food deposits and plaque, and prevents staining of the dentures.
• Daily before inserting dentures brush your gums, tongue and palate with a soft-bristled brush.
• If your denture breaks, chips, cracks or becomes loose consult your dentist. Do not try to repair it yourself. 

What are Dental Implants??

Dental implants are metal posts or frames which are placed in the jaw bone under the gums by surgery. The materials commonly used to make dental implants are titanium, aluminum oxide and surgical stainless steel. The implants after placement get fused with your jawbone. 

This then give a stable support for the artificial teeth or dentures and bridges. For a dental implant to be successful it should fuse with the jaw bone (a process called osseointegration). The metal titanium is accepted well as part of the body and it gets well bonded with bone.

There are basically two types of implants

• those which are placed into the bone and
• those which rest on top of the bone. 

Endosteal implant:

These are placed directly into the bone and it is the most commonly used type of implant. It is looks like a small cylinder or screw, almost functions as natural tooth roots and can be used for many purposes. The implant is inserted in the jawbone and after it fuses with the bone a metal collar called an abutment is attached to it. The crown, denture or bridge is eventually attached to the implant. 

Subperiosteal  implant: 

This is used in people with bone loss in the jaw (when jaw structure is limited). Specially made lightweight, individually-designed, metal framework is made to fit over the remaining bone. After the implant is placed natural tissue or bone grow around the implant make it more secure. It functions as equivalent of multiple tooth roots. It can be used to make a partial denture, bridge, crown or if needed even full denture. 

Intramucosal inserts: 

This type of implant is used with removable dentures

Your dentist after examining you can recommend the best type of implant for you. 

Placing Dental Implants

If you want an implant more than one dental professional will be involved in your treatment.

• An oral surgeon or a periodontist will place the implant in your jaw bone.
• A prosthodontist or general dentist will make crowns, bridges or dentures to be placed on the implant.
• The oral surgeon and the prosthodontist or general dentist will coordinate the treatment and decide how many implants are needed and when and where they should be placed. 

Before Placing an Implant

Implants can not be placed in everyone who wants it. Your dentist after examining you will tell if you are suitable to get an implant. 

Some considerations before you get an implant are

• You should have healthy gums and enough bone in the jaw to allow an implant to be placed in.
• If you have periodontal (gum) disease, infection or injury you may need antibiotics or other treatment for it before the implant is placed.
• Your jaw bone may need bone grafting or augmentation. In this procedure, before the implant is placed, your jaw bone is built up by bone grafting to increase the chance of implant success. 

Placing the Implants

You will need two surgeries to get the implant placed. Some newer implants can be placed in one go. 

The first surgery: 

Before the surgery you may be given antibiotics and pain relieving medication. The surgery is usually done under local anesthesia, but you may be given sedation if required. In the first surgery the implant is placed in your gums. After placing the implant your oral surgeon will take an X-ray of the area to confirm that the implant is where it should be. Time needed for surgery will depend on whether or not you need bone grafting and the number of implants that are placed. After the surgery you will be given antibiotics and pain relieving medications. Follow the instructions give by your dentist regarding medications, food and oral hygiene. In a few months (3 or 4 months in the lower jaw and 5 or 6 months in the upper jaw) the implant fuses with the jaw. 

The second surgery: 

The second surgery is done after the implant/implants have fused or integrated with your jaw bone. The surgery is usually done under local anesthesia, but you may be given sedation if required. During this surgery a metal healing abutment (collar) is placed on the implant. The healing abutment is placed where your tooth finally would be. It helps to maintain the space so that the gums surrounding the implant heal well and if the implant does not get successfully bonded with the bone your dentist can remove the implant.

Restoration

 Two or three weeks after the second surgery your dentist or prosthodontist will start the process of making crown, bridge or denture for you. 

Complications from Surgery 

Possible complications of implant surgery are

• Bleeding
• Infection
• Injury to nerves, sinus or nasal passage. Your dentist will do special X-rays to determine where the nerves, sinuses and nasal cavity are located. 

Implant Failure

 Most of the implant surgeries are successful (>90% success). In an occasional patient the implant may fail to bond with the surrounding bone. In this case the implant has to be removed and a second implant can be placed immediately or sometime later. 

Some common reasons for failure of implant to fuse with the surrounding bone are

• Trauma during surgery
• Infection of the tissue around the implant
• Smoking
• Lack of enough healthy bone around the implant.
• Allergy to titanium 

Late complications of implants are

• Infection around the implant which leads to a form of periodontal disease called periimplantitis. If it is not treated appropriately it can lead to bone loss, which could cause the implant to become loose. If the implant becomes loose it will have to be removed.
• The crown, bridge or denture over the implant can break, or the implant itself can get fractured. If the crown, bridge or denture breaks they can be repaired but a broken implant has to be removed.